EP0408358A2

EP0408358A2 - Intramuscular electrode for neuromuscular stimulation system

Info

Publication number: EP0408358A2
Application number: EP90307631A
Authority: EP
Inventors: William D. Memberg; Michael W. Keith; Paul Hunder Peckham
Original assignee: Case Western Reserve University
Current assignee: Case Western Reserve University
Priority date: 1989-07-14
Filing date: 1990-07-12
Publication date: 1991-01-16
Anticipated expiration: 2010-07-12
Also published as: ATE135242T1; DE69025814T3; EP0408358B1; US4989617A; EP0408358B2; DE69025814T2; DE69025814D1; EP0408358A3

Abstract

A helix (10) is defined by two lengths of multistrand wire (14) each surrounded by flexible, biocompatible insulation (18). A silicon elastic sheath (30) surrounds the helix and extends to a terminal end of the electrode. At the terminal end, a portion of the wire is wrapped around a periphery of the sheath to define a tissue contacting surface (34). A shaft (42) of a polypropylene anchor (40) is inserted into a hollow core (20) of the helix and thermally deformed into mechanical engagement with the helix. The anchor has a plurality of polypropylene tines or barbs (44) which firmly engage the tissue within which it is inserted but which yield for electrode removal without ripping the tissue.

Description

Background of the Invention

The present invention relates to implantable electrodes. It finds particular application in conjunction with functional neuromuscular stimulation systems and will be described with particular reference thereto.
The electrodes of neuromuscular stimulation systems are commonly implanted in the muscles of a patient's arms or legs. Generally, these electrodes are different from electrodes implanted in a patient's heart in conjunction with pacemakers to accommodate the differences in the muscular tissue and the manner and frequency with which the muscular tissue contracts.
One type of neuromuscular stimulation electrode includes a length of insulated wire in which the terminal one to one and a half centimeters has been stripped to expose the electrical conductor. The electrical conductor is folded back in a sharp V to form a barb. This exposed end and the immediately contiguous lead wire are inserted into a hollow bore in the canula of a syringe-like tool and "injected" into the muscle tissue. The barb defined by folding the exposed conductor back on itself inhibits the electrode from being extracted. One of the primary drawbacks to electrodes of this type is fatigue fallure of the electrical conductor.
Various electrode designs have been developed that improve upon the stripped end lead electrode. One improved electrode configuration is described in "Electrical Activation of Respiratory Muscles by Methods Other than Phrenic Nerve Cuff Electrodes", Peterson, Stellato, Nochomovitz, Dimarco, Abelson, and Mortimer, PACE, Vol. 12, pp. 854-860, May 1989, which publication is based on a paper presented at the Diaphragm Stimulation Symposium at Cardiostim '88, June 15 18, 1988. In this electrode, two Teflon coated multistrand stainless steel wires were wrapped in a double helical pattern. At the terminal end, about the last half centimeter of the Teflon coating of the helically wrapped conductors was removed. The bare stainless steel multistrand conductors were wrapped with the same helical pattern. A colored polypropylene core was threaded through the helix and another millimeter or so beyond the end of the bare wires. A plurality of lengths of polypropylene about a half centimeter long were bundled around the exposed end of the polypropylene core. The core and the surrounding elements were inserted about a millimeter into a conforming metal tube which was heated, e.g. with a soldering iron, until the polypropylene filaments fused to the polypropylene core as barbs at the terminal end. Once injected into the muscle, muscle tissue would grow around the exposed wire coil and the polypropylene barbs anchoring it securely.
Although successful, this electrode does have drawbacks. First, fusing the plurality of polypropylene barbs to the core is difficult and labor intensive. Second, the reduction in diameter at the end of the Teflon insulation where the stripped helix of electrical conductor begins is a natural failure point. Flexing movement is focused at this point during muscular movement, eventually leading to stress failures.
The present invention contemplates a new and improved electrode and its method of construction which overcomes the above referenced problems and others.
In accordance with one aspect of the present invention, an electrode configuration is provided in which a helix of electrical conductor is encased in a flexible plastic sheath. At a terminal, implanted end, the exposed electrical conductor is wrapped around an outer periphery of the encasing plastic sheath.
In accordance with another aspect of the present invention, at least one insulated electrical conductor is wrapped in an open core helix and surrounded by a flexible plastic sheathing. An anchor has a plurality of barbs and an elongated thermoplastic section which is received in the helix hollow core. The elongated section is thermally deformed into locking engagement with the insulated conductor helix.
One advantage of the present invention is that it anchors securely into muscle tissue.
Another advantage of the present invention is that it is resistant to stress failures of the electrical conductor.
Yet another advantage of the present invention is that it simplifies construction.
Still further advantages of the present invention will become apparent to those of ordinary skill in the art upon reading and understanding the following detailed description of the preferred embodiment.
The invention may take physical form in various parts and arrangements of parts or in various steps and arrangements of steps. The drawings are only for purposes of illustrating a preferred embodiment and are not to be construed as limiting the invention. The figures are illustrative of a method of constructing and inserting an electrode in accordance with the present invention and the resultant electrode. In the accompanying drawings:-

FIGURE 1A is a hollow core, double helical configuration of insulated multi-strand electrode lead;
FIGURE 1B illustrates the hollow core, double helical configuration encased in Silastic sheathing with de-insulated ends of the electrode lead wrapped around the sheathing with a polypropylene anchor ready for insertion;
FIGURE 1C is illustrative of the Silastic sheath coil, electrode end of FIGURE 1C, in partial section, with the anchor inserted;
FIGURE 1D is the assembly of FIGURE 1C with the anchor fused to the helical electrode lead;
FIGURE 2A is a probe for determining a point of insertion;
FIGURE 2B illustrates sliding a metal sheath or canula over the probe and withdrawing the probe;
FIGURE 2C illustrates inserting the electrode and a carrier into the metal sheath or canula after the probe has been removed;
FIGURE 2D shows the electrode inserted at the determined point of insertion;
FIGURE 2E illustrates removal of the carrier from the canula; and,
FIGURE 2F illustrates removal of the canula from the implanted electrode.

With reference to FIGURE 1A, a helix 10 is defined by a pair of electrical conductors 12a, 12b wound into an open core, double helical configuration. Each electrical conductor is selected to have a relatively low electrical resistance, high mechanical strength, high ductility, high fatigue resistance, and high corrosion resistance. The preferred conductors for multistrand wire 14a, 14b include Type 316 stainless steel, platinum alloys, such as platinum iridium, nickel cobalt chromium molybdenum alloys, and iron nickel cobalt chromium molybdenum alloys. The conductors are preferably seven strand wires arranged such that the strands pack in a hexagonal close packed pattern for optimum compactness. The wire strands are wound such that they have a pitch angle 16 of about 17° relative to a plane transverse to the cable axis in order to optimize tensile and compressive forces. In order to reduce electrical conductivity and increase redundancy, a third or additional conductor may be wound in the helix. However, the physical size of one or more additional conductors may necessitate increasing the pitch angle and reducing tensile or compressive strength.
The conductors 12 are insulated with a biologically inactive coating 18a, 18b which has a high tensile strength and ductility, such as TEFLON (Trade Mark), polyurethane, or silicon rubber. Optionally, the strength of the cable may be improved by winding the electrical conductors around a multistrand polymeric core, such as polypropylene. However, in the preferred embodiment, the helix has an open core 20 to increase the flexibility and fatigue resistance of the electrical conductors. Further, the conductors are wound with a gap 22 between adjacent windings to accommodate compressive, tensile, and bending stresses.
With reference to FIGURE 1B, the open core helix 10 is encased in a silicon rubber sheath 30 e.g. of "Silastic" material. In the preferred embodiment, the sheathing 30 is an open core tube within which the helix 10 is received. The sheath is preferably shrunk into firm frictional engagement with the helix. Tho sheathing 30 encloses the helix which prevents tissue around an implanted lead from growing into the helix. This reduces anchoring of the lead to the tissue and permits limited movement between the tissue and the lead. Optionally, in applications where greater anchoring is desirable, the sheathing may be eliminated in total or in part to enable the tissue to grow into the helix.
At a terminal or implanted end 32 of the sheathing 30, the TEFLON™ insulation 18 is removed and the de-insulated wire filaments 14 are wrapped around the exterior periphery of the silastic sheathing to define an electrically conductive surface 34 that conducts charge to surrounding tissue. The ends of the electrical conductors are fastened, such as by insertion through a segment of the sheathing 30 and sealing with silicon adhesive 36.
The length of the de-insulated wire is selected to provide a surface area 34 that delivers a charge density per stimulus pulse that is high enough to depolarize a nerve, but low enough to avoid tissue damage and electrode corrosion. This surface area is selected in accordance with the stimulus pulses to be applied and the nerve tissue to be stimulated. It will be noted that by de-insulating the electrical conductor and using the conductor itself as the electrode eliminates welds or other electrical junctions which could be subject to galvanic corrosion are avoided. Moreover, the diameter of the electrical lead windings is commensurate with the diameter of the silastic tubing, thus avoiding a diameter reduction or other point at which stresses are focused and stress failures become most apt to occur. The slight compression of the sheathing as the wire is wrapped renders the diameter of the conductive surface 34 substantially the same as the diameter of the uncompressed sheath diameter. Of course, for some applications or to facilitate production efficiency, it may be advantageous to connect the electrical leads with a separate metal element which at least in part surrounds the implanted end 32 of the sheathing.
A separate anchor 40 has a thermoplastic, polymeric shaft 42 of an appropriate diameter to be received in the hollow core 20 of the helix 10. The shaft portion and a plurality of tines 44 are anchored together in an anchor head portion 46. Preferably, the entire anchor is constructed of a polymeric material rather than a metal to avoid potential corrosion sites. Polypropylene is preferred as the polymeric anchor due to its ready availability in monofilament form and its biocompatibility. The monofilament polypropylene tines function as barbs to anchor the electrode securely, particularly while the muscle tissue is growing into firmer attachment with the electrode. However, the polymeric tines are also sufficiently flexible that the electrode can be removed surgically without the tissue damage associated with metal or rigid tines.
With reference to FIGURE 1C, the polymeric shaft 42 is inserted into the hollow core 20 of the leads 12 of the helix. The polymeric shaft is constructed of a thermoplastic with a lower softening point than the sheathing 30 or the insulation 18. The terminal end of the electrode is heated such that the shaft softens and flows into gaps 22 in the helix 10 as illustrated in FIGURE 1D. This flow anchors the shaft, hence the anchor to the electrode conductors 12, rendering them substantially inseparable. Moreover, the polymeric flow tends to seal the terminal end of the sheathing, limiting fluid permeability. Optionally, additional sealants may be added to inhibit biological fluids from flowing into the sheathing after the electrode is implanted.
The completed electrode is implanted into a selected point within the patient's muscle tissue. With reference to FIGURE 2A, a probe 50 that includes an inner conductive rod 52 that is covered with insulation 54, except at its two ends. During surgery, an incision is made into the skin and the probe is inserted therethrough into the muscle. A source of stimulus current 56 is selectively connected with the probe to induce a contractile response in the muscle. The probe is moved or repositioned until a desired contractile response is achieved.
With reference to FIGURE 2B, a metal sheath 58 is placed over the probe. The metal sheath is stainless steel tubing that has longitudinal slots cut into one end. The end of the metal sheath is positioned adjacent the end of the probe and the probe is withdrawn. With reference to FIGURE 2C, the electrode is placed in a lead carrier 60, such as half circular length of tubing which is dimensioned to be slidingly received in the metal sheath 58 and to receive the lead therein. The anchor is inserted into the metal sheath followed by the lead carrier and the remainder of the lead. The lead carrier advances the lead until the electrically conductive surface 34 is at the same position as the tip of the probe (FIGURE 2D). A depth of insertion gauging means 62 is provided for determining when the electrically conductive surface is in the same position relative to the inserted end of the metal sheath as was the probe. In the preferred embodiment, the depth of insertion gauging means includes a plurality of slots 64 in the metal sheath and a plurality of tabs 66 on the carrier. The slots and tabs are fashioned a coordinated length from the inserted ends of the metal sheath and carrier such that the electrically conductive surface 34 of the electrode is properly positioned.
With reference to FIGURE 2E, the carrier is removed from the metal sheath. Referring to FIGURE 2F, the metal sheath is slid longitudinally off the lead, relying on the anchor 40 to hold the lead at the selected location in the muscle tissue both during removal of the sheath and thereafter.
The invention has been described with reference to the preferred embodiment. Obviously, modifications and alterations will occur to others upon reading and understanding the preceding detailed description. It is intended that the invention be construed as including all such alterations and modifications.

Claims

1. An electrode for surgical implantation, the electrode comprising:
a helix of electrical conductor;
a flexible, insulating sheath surrounding and encasing the helix;
an exposed portion of the electrical conductor being wrapped around a periphery of a terminal end of the sheath to form an electrical contact for transmitting electrical energy to tissue surrounding the implanted electrode.

2. The electrode as set forth in claim 1 wherein the electrical conductor is a multistrand wire that is encased in insulation.

3. The electrode as set forth in claim 1 wherein the conductor includes two multi-filament wires, each encased in insulation and disposed side by side in the helix.

4. The electrode as set forth in claim 1 wherein the helix has a hollow core and gaps between adjacent loops of the electrical conductor.

5. The electrode as set forth in claim 4 further including an anchor for anchoring the electrode to tissue within which it is implanted, the anchor being connected with a terminal end of the electrode.

6. The electrode as set forth in claim 5 wherein the anchor includes a shaft of thermoplastic material which is received in the helix open core and has been heated to flow into conformity with the helix.

7. The electrode as set forth in claim 6 wherein the anchor includes a plurality of polymeric barbs, the barbs being sufficiently strong to anchor the electrode into the tissue within which it is transplanted and sufficiently resilient so as to yield and permit extraction of the electrode without ripping the tissue.

8. The electrode as set forth in claim 7 wherein the anchor barbs and shaft are constructed of polypropylene.

9. An electrode whose terminal end is implantable into tissue, the electrode comprising:
an open core helix of an electrical conductor which is electrically connected with an exposed electrical conductive surface adjacent a terminal end of the electrode for conducting charge into the tissue within which the electrode is implanted;
an anchor having a thermoplastic shaft extending therefrom, the anchor shaft being received in and thermally connected to the helix of insulated electrical conductor adjacent the terminal end.

10. The electrode as set forth in claim 9 wherein the helix is encased in a flexible, biocompatible sheathing, which sheathing terminates adjacent the terminal end.

11. The electrode as set forth in claim 10 wherein the exposed conductive surface is defined by an uninsulated length of the electrical conductor which is wrapped around a periphery of the sheathing adjacent the terminal end.

12. The electrode as set forth in claim 10 wherein the electrical conductor includes two lengths of multifilament wire, each sheathed in a biocompatible insulation wrapped in the helix adjacent to each other with gaps therebetween, the anchor shaft being thermally deformed into the gaps.

13. The electrode as set forth in claim 12 wherein the exposed conductive surface extends along a peripheral surface of the sheath.

14. The electrode as set forth in claim 10 wherein the anchor has a plurality of flexible tines that are connected with the anchor shaft.

15. The electrode as set forth in claim 14 wherein the shaft and tines are constructed of polypropylene.

16. A method of constructing an electrode comprising:
fashioning a helix of insulated electrical conductor;
sheathing the helix with a flexible insulating material;
at a terminal end of the sheathing, wrapping an exposed end of the electrical conductor around a periphery of the sheathing adjacent a terminal end thereof.

17. The method as set forth in claim 16 further including:
inserting a thermoplastic shaft of an anchor into an open core of the helix adjacent the terminal end; and,
thermally deforming the thermoplastic shaft into locking engagement with the helix.

18. The method as set forth in claim 16 further including inserting the electrode into a patient by inserting the probe into muscle tissue to select a point of electrode insertion, placing a metal sheath over the probe, removing the probe and inserting the electrode into the metal sheath, advancing the electrode through the metal sheath with a carrier until the exposed end of the conductor is at the selected insertion point, removing the carrier from the metal sheath, and removing the metal sheath from the electrode.

19. A method of fabricating an electrode comprising:
fashioning a helix of insulated electrical conductor extending to a terminal end;
heating a thermoplastic shaft of a plastic anchor to the helix adjacent the terminal end.

20. The method as set forth in claim 19 further including:
encasing the helix in a flexible, biocompatible insulator which extends to the terminal end;
de-insulating the electrical conductor adjacent the terminal end; and,
mounting the de-insulating conductor portion on a periphery of the sheathing.

21. The method as set forth in claim 20 further including inserting the probe into muscle tissue to select a point of electrode insertion, placing a metal sheath over the probe, removing the probe and inserting the electrode into the metal sheath, advancing the electrode through the metal sheath with a carrier until the de-insulated electrical conductor is at the selected insertion point, removing the carrier from the metal sheath, and removing the metal sheath from the electrode.

22. A method of inserting an electrode which has an anchor and an exposed electrical contact surface adjacent a terminal end thereof into muscle tissue, the method comprising:
inserting a probe into muscle tissue to select a point of electrical contact surface insertion;
inserting a sheath over the probe and removing the probe from the sheath;
removing the probe and inserting the electrode into the sheath;
advancing the electrode through the sheath with a carrier until the electrical contact surface is at the selected insertion point;
removing the carrier from the sheath; and,
removing the sheath from the electrode while the anchor holds the electrode in the muscle tissue.